Provider Demographics
NPI:1558409441
Name:DEGUZMAN, FERNANDO FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:FRANCISCO
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SW CAMPUS DR
Mailing Address - Street 2:#5-7
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5363
Mailing Address - Country:US
Mailing Address - Phone:253-988-3332
Mailing Address - Fax:
Practice Address - Street 1:3716 PACIFIC AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7836
Practice Address - Country:US
Practice Address - Phone:253-474-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117191Medicaid
WAAB34582Medicare ID - Type UnspecifiedMEDICARE
WA1117191Medicaid